TITLE:
Patients with dental hemorrhagic complicationsundergoing warfarin therapy exhibit excessiveinternational normalized ratio prolongation: A report of 2 cases
AUTHORS:
Tsuyoshi Sato, Yasuaki Sakata, Norimichi Nakamoto, Yousuke Fukushima, Aya Nakamoto, Yuichiro Enoki, Yoshie Sano, Shoichiro Kokabu, Tetsuya Yoda
KEYWORDS:
Warfarin Therapy; International Normalized Ratio; Hypoalbuminemia; Vitamin K Deficiency
JOURNAL NAME:
Open Journal of Stomatology,
Vol.3 No.1,
March
18,
2013
ABSTRACT: Dentalhemorrhagiccomplications,includingpostoperativebleedingandtraumatichemorrhageasemergencycases,oftenoccurinpatientsundergoingoralanticoagulanttherapysuchaswarfarintherapy.Recentresearchrecommendsthatwarfarindosageshouldbeassessedevery12weeks.Therefore,mostphysiciansgenerallyacceptinternationalnormalizedratio(INR)monitoringatlongerintervals.However,casesareencounteredinwhichtheINRprolongationisobserveddespiteofinvariabledosageofwarfarin.Inthisreport,wepresent2casesofpatientswithdentalhemorrhagiccomplicationsundergoingoralanticoagulanttherapywhoexhibitedexcessiveINRprolongation.Thesepatientsexhibiteddecreasedappetiteandhypoalbuminemia. Wespeculatethatlong-termappetitelossresultedintheincreaseintheserumconcentrationoffreewarfarin andvitaminK deficiency. Ourstudyindicates that weshouldnotice malnourishmentwhenwetreat patientswhohaveundergonewarfarintherapy with dentalsurgical procedures.Itisrecommendedthat measurementofINR just beforeadentalsurgicaltreatment.